Support

RUGCUTTERZ DANZ ARTZ

Please fill out the Contact Information Form below. Our staff will contact you by end of business day to complete your child's dance registration.

PERSONAL INFORMATION

Name *

Address *

City *

Postal Code *

Home Phone *

Home Email *

Date of Birth *

Gender *

Age *

CONTACT INFORMATION

Mother's Name

Work Phone

Cell phone

Email

Father's Name

Work Phone

Cell

Email

EMERGENCY CONTACT INFORMATION

Name

Phone Number

Relationship to Child

MEDICAL INFORMATION

Health Card Number

Allergies / Medications

If Yes, Please list

Medical Conditions

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I hereby certify that my child is in good physical condition and is able to participate fully in this program. All current medical conditions requiring medication are outlined above. I understand the inherent risk involved in the physical activity of dancing and I release Rugcutterz Danz Artz School and its teachers, directors, managers and owners from any liability in ase of accident or injury. I understand that all classes will be conducted in the safest possible manner by trained professional instructors. In addition, I hereby give permission to Rugcutterz Danz Artz to photograph and video my child for class purposes and that these photos and/or videos may be used for advertising purposes including ALL social media platforms.

TELL ME MORE

I’M INTERESTED, TELL ME MORE!

Fill out this form and one of our staff members will contact you by end of business day. We will be happy to answer your questions.

Name *

Home Phone *

Home Email *

Questions

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I am interested in available promotions. Tell me more!

I’M INTERESTED, TELL ME MORE!

Fill out this form and one of our staff members will contact you by end of business day. We will be happy to answer your questions.